Endoscope with Disposable Camera Shaft and for Imaging in Nonvisible Light

ABSTRACT

An endoscope. One or more image sensors are designed to capture image data in visible light. One or more image sensors are designed to capture image data in a nonvisible portion of the electromagnetic spectrum. An insertion shaft is designed to support the visible and nonvisible image sensors at or near a distal tip with sufficient rigidity to permit guidance to a surgical site in a human body. Image processing software is trained through machine learning to enhance image quality of at least the nonvisible portion of the image, and to present the enhanced nonvisible image as a real-time, visible presentation to a surgeon. A handle has electronics for drive of illumination circuitry and to receive imaging signal from the imaging circuitry. A joint between the proximal handle portion and the insertion shaft is designed to separably connect the insertion shaft to the proximal handle portion. When separated, the joint permits removal of the insertion shaft for disposal and replacement.

This application claims priority, as a non prov. of provisional of U.S.Provisional Application Ser. No. 62/841,163, filed Apr. 30, 2019, titled“Endoscopes with Disposable Camera Shaft and for Imaging in NonvisibleLight”. The entire disclosure of the '163 application, of U.S.Provisional applications 62/682,585, filed Jun. 8, 2018, and 62/722,150,filed Aug. 23, 2018, both titled “Endoscope with Disposable CameraShaft,” are incorporated by reference.

BACKGROUND

This application relates to endoscopes, laparoscopes, arthroscopes,colonoscopes, and similar apparatus, instruments, implements, orprocesses specially adapted or intended to be used for evaluating,examining, measuring, monitoring, studying, or testing living or deadhuman and animal bodies for medical purposes.

SUMMARY

In general, in a first aspect, the invention features an endoscope. Oneor more image sensors are designed to capture image data in visiblelight. One or more image sensors are designed to capture image data in anonvisible portion of the electromagnetic spectrum. An insertion shaftis designed to support the one or more visible and nonvisible imagesensors at or near a distal tip with sufficient rigidity to permitguidance to a surgical site in a human body. Image processing softwaretrained through machine learning to enhance image quality of at leastthe nonvisible portion of the image, and to present the enhancednonvisible image as a real-time, visible presentation to a surgeon.

Embodiments of the invention may include one or more of the followingfeatures. The software may be programmed to display the visiblepresentation of the nonvisible image as a split-screen display with thevisible light image data. The software may be programmed to display thevisible presentation of the nonvisible image overlaid or merged with thevisible light image data. The software may be programmed to overlay ormerge the nonvisible image with the visible light image data byregistering for parallax differences. The software may be programmed tooverlay or merge the nonvisible image with the visible light image databy recovering three-dimensional spatial relationships. An ultraviolet orinfrared LED may be mounted within the endoscope to illuminate tissue inthe field of view of the nonvisible image sensor. The one or more imagesensors may be designed to capture image data in visible light and theone or more image sensors designed to capture image data in a nonvisibleportion of the electromagnetic spectrum are designed into a single imageplane. An electronic shutter may chop for alternate illumination betweenmultiple illumination sources of differing wavelength or alternatesensing between image sensors of differing wavelength sensitivity. Astrobe circuit may chop for alternate illumination between multipleillumination sources of differing wavelength.

The one or more image sensors designed to capture image data in visiblelight, the one or more image sensors designed to capture image data in anonvisible portion of the electromagnetic spectrum, and image processingsoftware are designed to capture image data from tissue below a surfaceat the field of view of the image sensors.

The one or more image sensors designed to capture image data in visiblelight and the one or more image sensors designed to capture image datain a nonvisible portion of the electromagnetic spectrum and imageprocessing software are designed to capture image data from tissue belowa surface at the field of view of the image sensors. Tissue in the fieldof view of the nonvisible image sensor may be infused with contrastfluorescent dye.

The above advantages and features are of representative embodimentsonly, and are presented only to assist in understanding the invention.It should be understood that they are not to be considered limitationson the invention as defined by the claims. Additional features andadvantages of embodiments of the invention will become apparent in thefollowing description, from the drawings, and from the claims.

DESCRIPTION OF THE DRAWINGS

FIGS. 1(a), 1(b), 1(c), 1(d), 2(d), 3(a), 3(f), 3(h), 4(a), and 5(a),5(b), and 5(d) are perspective views of endoscopes.

FIGS. 2(a), 2(b), and 2(c) are plan views of endoscopes.

FIGS. 3(b), 3(c), 3(d), 3(e), 3(g), 4(b), 4(c), 4(d), and 5(c) showendoscopes, partially cut away.

FIG. 6 is a perspective view of endoscope handles in a sterilizer.

DESCRIPTION

The Description is organized as follows.

-   I. Overview-   II. Reposability: partially reusable, partially    disposable/replaceable, and a coupling joint between-   III. Surgical Imaging Combining Visible and Nonvisible Light    -   III.A. Imaging sensors for nonvisible light    -   III.B. Illumination and contrast for nonvisible imaging    -   III.C. Image processing-   IV. Additional features of an endoscope-   V. Other embodiments

I. Overview

Referring to FIGS. 1(a), 1(b), 1(c), and 1(d), a surgical endoscope 100may be structured to permit detachment of a shaft 110 portion from theendoscope's handle 112, 114. A camera or image sensor at tip 116 of theshaft, any panning mechanism, illumination, power and signal connectors,and fluid flow channels may be in the disposable shaft 110. Handle 112,114 may be designed to be reusable (which implies that handle 112, 114may be sterilizeable, for example in an autoclave or other sterilizationdevice, or protectable by a disposable sterility sleeve). Joint 130between the detachable shaft and the reusable parts of handle 112, 114may be generally distal in the handle (but not necessarily at thedistal-most end). The replaceable shaft portion 110 may be disposable,along with a disposable portion 120 of the handle that is disposablewith shaft 110.

II. Reposability: Partially Reusable, Partially Disposable/Replaceable,and a Coupling Joint Between

Referring to FIGS. 1(a), 1(c), 2(a), 2(b), 2(c), 2(d), and 3(a), thehandle of the endoscope 100 may include three principle components:

-   -   The disposable cap 120. This distal-most portion of the handle        may serve as a mounting base for shaft 110, and may disconnect        from the remainder 112, 114 of the handle. This disposable cap        portion 120 (along with shaft 110 and componentry inside) may be        disposable.    -   Rotation collar 112 may have surface features 302, 304 to allow        a surgeon to rotate the rotation collar 120 about the central        axis of the handle, that is, about the roll axis 126 of the        shaft. During surgery, insertion shaft 110, disposable cap 120        and rotation collar 112 may be locked to rotate with each other,        so that rotating the rotation collar effects rotation 126 of the        disposable cap 120 and shaft 110.    -   Proximal stationary handle 114 has a shell surrounding        componentry within the handle. The outer diameter and outer        surface of handle 114 may be designed to provide an easy and        low-slip grip for a surgeon's hand. Joint 128 between the        proximal handle and rotation collar may allow these two        components to rotate relative to each other. In some cases, a        circuit board and similar componentry inside proximal handle 114        may rotate with disposable cap 120 and rotation collar 112,        inside proximal handle 114.        Disposable cap 120 and rotation collar 112 may be separable from        each other at joint 130, so that disposable cap 120 and shaft        110 may be disposable, while handle 114 and rotation collar 112        (and componentry inside them) are reusable.

Referring to FIGS. 1(a), 1(c), 1(d), and 3(a), between the disposablecap 120 and rotation collar 112, three basic connections may be made:

-   -   A rotation-locking coupling 140, 142 to hold the disposable        portion 120 to the reusable handle 112, 114. Coupling 140, 142        may have sufficient strength to transmit insertion and        withdrawal forces, roll, pitch, and yaw torques, lateral forces,        and similar forces from the proximal reusable handle 112, 114 to        the distal disposable portion 120 and shaft 100, thereby to        allow a physician to aim the illumination and/or camera as        needed. Joint 130 between disposable cap 120 and rotation collar        112 may lie generally toward the distal end of the handle. The        disposable cap and rotation collar 112 may engage through flat        force-transmittal surfaces 144 at the center of joint 130 and        around the circumferences, so that these forces are supported        around the circumference of separable joint 130. One or more        release buttons 146 may be pressed or squeezed to cause one or        more locking snaps 148 to disengage. The mechanical connection        may include a rotatable locking ring or other release/fixation        mechanisms.    -   An electrical connection to supply power to the illumination        source and camera, and to carry optical signals back from the        camera to the processing board in handle 112, 114 and display        system outside the endoscope. The disconnectable electrical        connections for power and signal may be effected by a USB-C        connector 150, 152, mini HDMI connector, or similar connector        that can maintain signal integrity for high speed signals. If        illumination is conveyed by optical fiber, joint 130 may include        an optical connector.    -   A disconnectable connection to any panning mechanism for the        camera may be effected by a physical connector, such as a        linkage.

In some cases, the camera/image sensor, LED, and electronic connections(and any mechanical connections for panning the camera/image sensor) maybe removable from insertion shaft 110. Shaft 110 and cap 120 may besmooth and simple enough in shape to allow easy sterilization.Similarly, once the electronics are removed from interior of shaft 110,they may be sterilizeable as well. it may be cost-effective, especiallyin lower-labor-cost markets, to disassemble, sterilize, and reassemblethe shaft and its interior components for reuse.

One or more fluid hoses 160 for irrigation liquid or inflation gas (ortwo hoses, one for fluid and one for gas) may enter through disposablecap 120, so that the entire set of fluid tubing for theirrigation/inflation channel may be disposable with the disposable shaftportion. In other cases (e.g., FIGS. 5(a) and 5(b)), a fluid hose 162may enter the proximal end of the scope, and disconnectable fluidconnections within joint 130 for fluid inflow and outflow may beeffected by gaskets, O rings, and the like. Alternatively, connectorsfor the hoses may be outboard of the endoscope itself, either near theendoscope (for applications where it may be desirable to allow “quickchange” replacement of the insertion shaft in the course of a singleprocedure), or far from the endoscope, typically at the receptacle forwaste fluid, to ease disposal of all hoses that are potentiallycontaminated by contact with the patient.

Disposable shaft 110, 120 may be designed to facilitate disposability ofcomponents that come into contact with bodily fluids. Becausesterilization is often imperfect, patient safety may be improved bydisposing of components that have come into contact with patient bodilyfluids. To improve sterilizability, it may desirable to reducecomponentry in the disposable component 110, 120 so that cost of thedisposable component may be reduced, and to reduce surface features andcrevices that may be difficult to sterilize. Thus, the lens, imagesensor, LED, panning mechanism, and shaft may be disposable. Inaddition, because shaft 110 is used for fluid inflow and outflow, and isdisposable, sealing against bodily fluids may be unnecessary.

Referring to FIG. 5(c), hoses 160, 162 for irrigation/insufflationfluid/gas in, irrigation/insufflation fluid/gas out, and electricalconnection cord 164 may be permanently affixed 540, 542 to disposablecap 120. This arrangement may allow that hose 162 that carries water outof the surgical cavity, and which is therefore contaminated, may bedisposable, and no fluid will come into contact with the reusable part114 of the handle. Hoses and cord 160, 162 may be routed through channel554 running the length of reusable handle 112, 114. Channel 544 may beof inner diameter large enough to permit easy passage of hoses and cord160, 162, 164, and connectors 550, 552, and have a continuous smoothwall that permits easy sterilization, to permit ready replacement of thereplaceable components. Channel 554 may be off the central axis, toallow printed circuit board 422 to lie on the central axis. Connectors550, 552 at the end of hoses and cords 160, 162 may be small enough topass through channel 554. Thus, replacement of shaft 110, cap 120, hosesand cords 160, 162 may be effected by threading connectors 550, 552 andhoses and cord 160, 162 through channel 544. Electrical cord 164 mayhave a connector 554 at or near joint 130, and hose(s) 160 forirrigation/insufflation fluid/gas flowing into the surgical cavity maylikewise have a connector at joint 130 to allow this hose(s) to bereusable, or may be permanently affixed 540 to reduce possibility ofleaking. Having hoses and cable 160, 162 roughly on-axis reducesundesirable cable flop as the scope is in use, and reduces undesirabletorque on cap 120. Forming shaft 120, cap 120, and hoses 160, 162 as anintegral unit for replacement reduces possibility of leaking, andimproves sterility of the replacement operation.

Referring to FIG. 5(d), the replaceable/disposable shaft and itsmounting componentry may be specialized to different types of surgery.For example, a replaceable disposable cap/shaft unit 110, 120 forlaparoscopic thoracic surgery may have a shaft of 400 mm length anddiameter of 10 mm. Replaceable components for arthroscopic surgery ofknees and hips may be 155 mm in length, and 5.5 mm or 4 mm in diameter.For small joints, a replaceable shaft of 2.9 mm diameter or less may bepreferred. Typical dimensions for various surgical specialties may be asfollows (measured in millimeters):

Cannula Scope diameter diameter Scope Type Discipline Min Max Min MaxArthroscope (small joint) Arthroscopy 2.8 4.0 1.9 2.9 Arthroscope (largejoint) Arthroscopy 4.7 6.0 2.9 5.7 Cytoscope Cytoscopy 2.9 5.7Encephaloscope ENT 2.0 4.0 Hysteroscope Gynecology 3.7 7.0 2.0 5.0Laparoscope Laparoscopy 2.0 10.0 Sinuscope ENT 2.0 4.0 ThoracoscopePulmonary 10

Various replaceable components 110 may have different instruments at tip116. For example, various replaceable shafts may have cameras orientedat 0° (directly on-axis), 30°, 45°, 70°, and 90°.

Referring to FIG. 1(b), disposable shaft portion 110, 120 may in turn beseparable into an outer cannula 132 for protection and strength, and aninner shaft portion 134 carrying various illumination, optical, andfluid-carrying componentry.

III. Surgical Imaging Combining Visible and Nonvisible Light

A surgical endoscope may be equipped with image sensors that image innonvisible light, such as infrared or ultraviolet. Image processingtechniques, especially those based on artificial intelligence andmachine learning, may be used to enhance the nonvisible light image.Images formed from both visible and nonvisible signals may be displayed,either in split screen or as an integrated false color image, to asurgeon during surgery.

Illumination may be in visible light, infrared, and/or ultraviolet. Insome cases, the illumination LED (light emitting diode) may be placed inreusable handle 112, 114, and the disposable shaft may have fiber opticsto transmit light to the tip, and joint 130 may have an optical coupler.In other cases, the illumination LED may be placed in tip 116 toilluminate the surgical cavity directly; in such cases, joint 130 mayhave a power connector. In some cases, the LED may be recessed from thetip, or placed somewhere in the shaft, and optical fiber may carryillumination light to the tip. The optical fiber may be configured, forexample, with a split, so that light will be arrayed in a desiredpattern around the image sensor to better distribute the light into thesurgical cavity around the image sensor.

Nonvisible light imaging may be useful in a variety of situations. Somenonvisible wavelengths transmit through tissue more easily than visiblelight does. In such cases, imaging from nonvisible spectrum may becombined with visible light imaging to reveal subsurface structure orphysiology. In other cases, various tissues reflect or fluoresce atvarying wavelengths depending on physiological state. For example,tissues absorb light in the 320-380 nm (ultraviolet) range, andfluoresce at 440-480 nm (blue) more strongly when anoxic (oxygenstarved) than when normoxic. In other cases, contrast dye may beintroduced into tissue to fluoresce at certain wavelengths, to definetissue boundaries, or that fluoresces depending on physiological state.An endoscope that images in nonvisible wavelengths may provide a surgeonwith better information about tissues at a surgical site, allowingbetter surgical outcomes. In some cases, a single endoscope tip maysense at multiple wavelengths. In other cases, endoscopes with differentimaging wavelength bands may be provided, to be used in alternation.

III.A. Imaging Sensors for Nonvisible Light

An endoscope may be equipped with imaging sensors that image innonvisible light, or sensors that image in both visible light andnonvisible light. This may be accomplished by means such as—

-   -   A conventional CCD or CMOS sensor array may be sensitive into        the near infrared. For example, the red sensels (sensing image        elements, the sensing equivalent of display pixels) may detect        beyond the visible spectrum into the near infrared. This near        infrared signal may be separated out, for example, by        subtracting an image taken with another image sensor with a        narrower wavelength sensitivity band. The nonvisible image may        be processed for display.    -   A CCD or CMOS image plane whose sensels are sensitive in four        colors, for example, in infrared, red, green, and blue (as        opposed to conventional visible light sensors that image red,        green, and blue) may be used.    -   Two image planes may be placed side-by-side, one a conventional        RGB visible light image plane and one sensitive to nonvisible        light. In such a case, the image-merging software may account        for parallax effects of the spatial offset in addition to        merging of images. This, in turn, may have the additional        advantage of using the binocular parallax to resolve        three-dimensional information.    -   The image plane may have a frequency-filter shutter that can be        controlled to rapidly switch between visible-light bandpass to        infrared bandpass, much as liquid crystal display planes switch        between transparent and opaque,

In general, it may be desirable to capture image data at a high framerate. This may permit image processing software to employ sub-pixelanalysis to recover higher resolution image data.

III.B. Illumination and Contrast for Nonvisible Imaging

An endoscope may be equipped with multiple illumination LEDs, one ormore in visible wavelengths, and one or more in nonvisible wavelengths.The endoscope's field of view may be illuminated by tunable lasers,variable spectrum LEDs, pulse-width modulation among LEDs of differentwavelength, and similar techniques, to produce illumination of imagedtissue in nonvisible wavelengths.

If the sensing CCD or CMOS planes are under-sensitive to somewavelengths, the illumination sources may be tuned to compensate byover-illuminating at those wavelengths.

Because LEDs can be flashed extremely rapidly, multiple LEDs of varyingwavelength may be strobed rapidly, frame-by-frame, to image at differentwavelengths. Images at successive frames may be combined as discussed insection III.C, following.

In some cases, the tissue may be dyed with a contrast, such asindocyanine green (ICG) which is used to visualize lymph nodes,lymphatic pathways, vessels, and tissue borders. For example, ICG may beused to identify lymph nodes in cancer surgery, or to identify diseasedvs. healthy liver segments for liver resection. ICG fluoresces in nearinfrared. An endoscope that can image this infrared fluorescence may beused to more precisely identify tissue to be resected.

III.C. Image Processing

Image processing techniques may be used to process the image, forexample, to improve contrast, to extract features in under-saturated oroversaturated parts of the image, to sharpen edges, to identifystructures and boundaries, etc. Image-matching or image-stitchingtechnology may be used to integrate multiple images from visible lightand nonvisible light sensors into a composed false color image. Theimage processing may be based on artificial intelligence and machinelearning techniques.

The images from the multiple image sensors may be merged. Example imagemerging technologies include HDR (high dynamic range imaging) thatreceives multiple images of the same scene, taken in different lightingconditions, and uses the multiple images to correct for over-saturationand under-saturation in parts of the image. HDR techniques that learnvia machine learning may be adapted for use with the multiplewavelengths imaged by an endoscope. Surgical video may be captured athigh frame rates, and various video channels may be merged into lowerframe-rate but higher image quality video. Known techniques for imagemerging of the various images may be used.

Feature recognition may be used to register the two images. Images fromtwo different image sensors may be brought into registration usingstereoscopic vision registration techniques. If two image sensors arespaced apart, parallax differences between the two image sensors may beused to recover three-dimensional information.

Techniques for merging of single images may be used on successive framesof video to merge various video channels at different wavelengths.

A combined image may be formed by a number of false color renderingtechniques. The nonvisible image may be preprocessed, for example toidentify edges and to expand contrast. The visible image may be“squeezed” into part of the visible spectrum, so that the nonvisibleimage may be rendered in the freed-up part. The nonvisible image may beoverlaid on the visible image using a part of the spectrum that does nototherwise appear in the image. The display system may permit flashingback and forth between the visible image and an image rendered from thenonvisible sensors.

Multiple images taken in parallel in different lighting may bejuxtaposed on a single split-screen display.

IV. Additional Features of an Endoscope

Referring to FIGS. 2(a), 2(b), 2(c), and 2(d), the endoscope may have ahandle 112, 114, 120, and a shaft 110 for insertion into a body. At ornear distal tip 116 of the shaft 110 may be a camera, electronic imagesensor, or other optical component. The camera's orientation may befixed in the scope, or may be pannable. The camera may be at tip 116,looking out from the shaft, or may be recessed a short distance behindthe structural tip of the shaft. Also at or near the tip may be anillumination source, such as an LED. Tip 116 may have a rigid pointedtocar tip, or may have a spoon-shaped portion that reaches past theimage sensor, or may be flexible (in the manner of the tip of acolonoscope), in each case extending a little beyond imaging camera toprovide physical protection to the camera/image sensor during insertionor to protect the camera/image sensor from a surgical cutting device.

The shaft 110 itself may be rigid, made of a nonbioreactive metal suchas stainless steel or coated aluminum. In some cases, a surgical cavityaround the endoscope tip may be insufflated by gas (typically carbondioxide), or irrigated by saline solution. In either case, fluid inflowand outflow may be effected by channels through the shaft.

Shaft 110 may also carry power wires to the illumination LED and thecamera, and carry signal wires that carry an optical signal back fromthe camera to electronics in the reusable portion 112, 114 of thehandle. Electrical power to the camera may be supplied over conductorsin a flexible cable or on a printed circuit board (flexible or rigid),and insulated with a conformal and insulating coating such as parylene.This same flexible circuit board may have signal conductors for thevideo signal from the camera. The video signal may be transmitted fromthe camera to the handle using any video signal protocol, for example,MIPI (Mobile Industry Processor Interface) or HDMI. Parylene may alsoimprove biocompatibility.

Shaft 110 may also carry cables or other mechanical elements to controlpanning of the camera.

Referring to FIG. 3(a), rotation collar may have various features thatmake rotation easy. For example, depressions 302 may provide a good gripfor fingers for light roll torque. Fin 304 may provide greater leveragefor greater roll torque, and may also provide a fixed rotational pointof reference.

A button 310 may perform various functions, such as turning illuminationLED on or off, taking pictures, starting and stopping video, and thelike. A single button may perform all these functions based on thenature of the press. For example, press-and-hold for 3 seconds may turnthe illumination LED on and off. A quick press may capture asingle-frame still picture. A double-click may start and stop videorecording.

If the camera at the tip 116 of shaft 110 is pannable or has othercontrollable features, there may be a control (for example, a lever, ora touch-slide panel, etc.) near button 310 to control that adjustment ofthe camera.

Referring to FIG. 3(b), the camera may be placed slightly remote fromtip 116. Metal distal from the camera may be useful to protect thecamera and its mounting from large forces that can exist duringinsertion into the surgery site, and may protect the camera fromsurgical instruments such as shavers and cutters, and keep the cameraclean from bodily fluids. The space around the camera may be used tocirculate insufflation fluid (water or gas) or cleaning fluid (typicallywater).

One or more ultraviolet LEDs may be placed inside handle 112,114, insideshaft 110, or near tip 116 to assist with insuring sterility of theinternal components of the device or of the water as it passes thru thedevice

Referring to FIG. 3(c), irrigation/insufflation hose(s) 160, 162 mayenter at various points through the handle. For example,irrigation/insufflation hose(s) 160, 162 may enter through fin 304. Or,as shown in FIGS. 5(a), and 5(b), irrigation/insufflation fluid/gashose(s) 160, 162 may enter through the proximal end of handle 114. Thishose may then be disconnectable via a fluid disconnect joint 320 withinjoint 130. Referring to FIG. 3(d), in cases where hose(s) 160 forinsufflation fluid/gas enters through disposable cap 120, various jointsand strain relief features 340 may be used to hold hose(s) 160 in place.

Referring to FIG. 3(e) and FIG. 3(h), electrical connectors 150, 152such as USB-C or mini-HDMI connectors may be used to connect the camerato a circuit board interior to handle 114.

Referring to FIG. 3(e), in cases where a hose 160 for insufflation fluidenters through reposable cap 120, various joints and strain relieffeatures 340 may be used to hold hose 160 in place.

Referring to FIG. 3(f), rotation-locking coupling 140, 142 may lockdisposable cap 120 in rotational relationship to rotation collar 112.Various rigid and resilient features 144, 148 may lock them together forother forces and torques, and release buttons 146 may permit them todisengage to allow replacement of disposable cap 120.

Referring to FIG. 3(g), rotation between the handle's stationary portion114 and rotation collar 112 may be provided via a rotational bearing 360at joint 128.

Referring to FIGS. 4(b) and 4(c), proximal handle 114 may contain anumber of components, typically components that have only incidentalpatient contact (and therefore present less risk of cross-infection),are higher in cost (and therefore desirably reusable), and eithersterilizeable or may be covered by a sterility sleeve. For example,proximal handle 114 may hold power transformers, signal amplifiers,controls for the illumination LED and camera, a mechanical control forpanning the camera, rotation sensors for righting of an image from thecamera, and the like. The handle may also include connections toexternal sources and destinations of power, signal, fluid, and the like.

Proximal handle 114 may include rotational sensors so that an angularorientation of the camera may be ascertained. For example, the innersurface of proximal handle 114 may mount one or more magnets 420, andprinted circuit board 422 (which rotates with rotation collar 112 anddisposable cap 120) may have sensors 424 that detect the magnets. Thismay be used to compute a rotational orientation, which may in turn beused to “right” the image from the camera on a video display screen.

The distal tip of the shaft, the camera mounted therein, and themounting of componentry within the shaft may be designed to be robust.Occasionally, during surgery, the tip of the endoscope may come intocontact with a shaver, ablation probe, or cauterization probe, and itmay be desirable to have the tip be robust to such contacts. To reducerisk that componentry may be dislodged and left in the patient, thedisposable shaft and its componentry may be designed to avoid jointsthat are at high risk of mechanical failure. A disposable optical systemmay prevent the image degradation that occurs when nondisposable opticsare reused in multiple surgical procedures.

Endoscopes as a genus include arthroscopes, laparoscopes, colonoscopes,and other specialized scopes for various body cavities. For anarthroscope for joint surgery, the shaft may be as small as 5 mm, 5.5mm, or 6 mm, and highly rigid. For other endoscopes, such as acolonoscope, the diameter may be larger, and the shaft may be flexible.

The endoscope may be delivered as a handle and multiple tips, each tipindividually sealed for sterility.

Referring to FIG. 6, reusable handles 112, 114 may be sterilized in asterilizer 600. Preferably, hose(s) 160, 162 and all other portions ofendoscope 100 that come into contact with the patient, or with fluidsthat have come into contact with the patient, are disposable, and thedesign for reusable portions 112, 114 ensures that contamination isminimized through avoiding contact with the patient's bodily fluids.Sterilizer 600 may be arranged to accept one or more reusable handles112, 114, and irradiate them with ultraviolet light from ultravioletLEDs 602. Rods 610 that pass through handle channel 544 may haveultraviolet LEDs 612 arranged along their lengths, to sterilize internalchannels 544.

V. Other Embodiments

In general, in a first aspect, the invention features an endoscope. Theendoscope has a handle and an insertion shaft. The insertion shaft hassolid state illumination and imaging circuitry at or near a tip designedto provide illumination and imaging of the interior of a body cavity fora surgeon during surgery. The proximal portion of the handle haselectronics for drive of the illumination circuitry and to receiveimaging signal from the imaging circuitry, the proximal handle portionbeing designed to permit sterilization between uses. A joint between theproximal handle portion and the insertion shaft is designed to separablyconnect the insertion shaft to the proximal handle portion. When it isseparated, the joint permits removal of the insertion shaft for disposaland replacement. The joint is designed so that, when connected, thejoint can transfer mechanical force from a surgeon's hand to theinsertion shaft, and provides electrical connectivity between theproximal handle circuitry and the illumination and imaging circuitry.

In general, in a second aspect, the invention features a method forperformance with an endoscope having a handle and an insertion shaft,the insertion shaft having solid state illumination and imagingcircuitry at or near a tip designed to provide illumination and imagingof the interior of a body cavity for a surgeon during surgery, and theproximal portion of the handle having electronics for drive of theillumination circuitry and to receive imaging signal from the imagingcircuitry, the proximal handle portion being designed to permitsterilization between uses; and a joint between the proximal handleportion and the insertion shaft designed to separably connect theinsertion shaft to the proximal handle portion. The joint is separatedto permit removal of the insertion shaft for disposal and replacement.The joint is reconnected with a new insertion shaft, the connectiondesigned to provide mechanical force transfer between a surgeon's handto the insertion shaft, and electrical connectivity between the proximalhandle circuitry and the illumination and imaging circuitry.

Embodiments of the invention may include one or more of the followingfeatures. The handle may have proximal and distal portions. The distalportion may lie between the insertion shaft and proximal handle portion.The insertion shaft may be rigidly affixed to the distal handle portion.The joint may be disposed to connect and disconnect the distal andproximal portions of the handle. The distal handle portion may bedesigned to indirectly transfer mechanical force between a surgeon'shand to the insertion shaft, and provide indirect electricalconnectivity between the proximal handle circuitry and the illuminationand imaging circuitry. The handle may have a rotation collar havingsurface features designed to assist the surgeon in rotating theinsertion shaft in the roll dimension about the axis of the insertionshaft relative to the proximal handle portion. The electronics insidethe proximal handle portion may be designed to sense roll of theinsertion shaft, and provide an angular rotation signal designed topermit righting of a displayed image received from the imagingcircuitry. A mounting for the image sensor may be designed to permitpanning of the image sensor about a pitch or yaw axis perpendicular tothe central axis of the insertion shaft. One or more ultraviolet LEDsinternal to the endoscope may be designed to sterilize a region of theinterior of the endoscope. Hoses for insufflation fluid or gas may bedesigned on lie on or near a central axis of proximal handle portion.Two or more insertion shafts each having dimensions different than theothers, may each be connectable to the proximal handle portion at thejoint, to permit use of the proximal handle in surgery with differentrequirements for insertion shaft. A sterilization cabinet may bedesigned to sterilize components of the endoscope.

Various processes described herein may be implemented by appropriatelyprogrammed general purpose computers, special purpose computers, andcomputing devices. Typically a processor (e.g., one or moremicroprocessors, one or more microcontrollers, one or more digitalsignal processors) will receive instructions (e.g., from a memory orlike device), and execute those instructions, thereby performing one ormore processes defined by those instructions. Instructions may beembodied in one or more computer programs, one or more scripts, or inother forms. The processing may be performed on one or moremicroprocessors, central processing units (CPUs), computing devices,microcontrollers, digital signal processors, or like devices or anycombination thereof. Programs that implement the processing, and thedata operated on, may be stored and transmitted using a variety ofmedia. In some cases, hard-wired circuitry or custom hardware may beused in place of, or in combination with, some or all of the softwareinstructions that can implement the processes. Algorithms other thanthose described may be used.

Programs and data may be stored in various media appropriate to thepurpose, or a combination of heterogenous media that may be read and/orwritten by a computer, a processor or a like device. The media mayinclude non-volatile media, volatile media, optical or magnetic media,dynamic random access memory (DRAM), static ram, a floppy disk, aflexible disk, hard disk, magnetic tape, any other magnetic medium, aCD-ROM, DVD, any other optical medium, punch cards, paper tape, anyother physical medium with patterns of holes, a RAM, a PROM, an EPROM, aFLASH-EEPROM, any other memory chip or cartridge or other memorytechnologies. Transmission media include coaxial cables, copper wire andfiber optics, including the wires that comprise a system bus coupled tothe processor.

Databases may be implemented using database management systems or ad hocmemory organization schemes. Alternative database structures to thosedescribed may be readily employed. Databases may be stored locally orremotely from a device which accesses data in such a database.

In some cases, the processing may be performed in a network environmentincluding a computer that is in communication (e.g., via acommunications network) with one or more devices. The computer maycommunicate with the devices directly or indirectly, via any wired orwireless medium (e.g. the Internet, LAN, WAN or Ethernet, Token Ring, atelephone line, a cable line, a radio channel, an optical communicationsline, commercial on-line service providers, bulletin board systems, asatellite communications link, a combination of any of the above).Transmission media may include coaxial cables, copper wire and fiberoptics, including the wires that comprise a system bus coupled to theprocessor. Transmission may occur over transmission media, or overelectromagnetic waves, such as via infrared, WiFi, Bluetooth, and thelike, at various frequencies using various protocols. Each of thedevices may themselves comprise computers or other computing devices,such as those based on the Intel® Pentium® or Centrino™ processor, thatare adapted to communicate with the computer. Any number and type ofdevices may be in communication with the computer.

A server computer or centralized authority may or may not be necessaryor desirable. In various cases, the network may or may not include acentral authority device. Various processing functions may be performedon a central authority server, one of several distributed servers, orother distributed devices.

For the convenience of the reader, the above description has focused ona representative sample of all possible embodiments, a sample thatteaches the principles of the invention and conveys the best modecontemplated for carrying it out. The invention is not limited to thedescribed embodiments. Well known features may not have been describedin detail to avoid unnecessarily obscuring the principles relevant tothe claimed invention. Throughout this application and its associatedfile history, when the term “invention” is used, it refers to the entirecollection of ideas and principles described; in contrast, the formaldefinition of the exclusive protected property right is set forth in theclaims, which exclusively control. The description has not attempted toexhaustively enumerate all possible variations. Other undescribedvariations or modifications may be possible. Where multiple alternativeembodiments are described, in many cases it will be possible to combineelements of different embodiments, or to combine elements of theembodiments described here with other modifications or variations thatare not expressly described. A list of items does not imply that any orall of the items are mutually exclusive, nor that any or all of theitems are comprehensive of any category, unless expressly specifiedotherwise. In many cases, one feature or group of features may be usedseparately from the entire apparatus or methods described. Many of thoseundescribed alternatives, variations, modifications and equivalents arewithin the literal scope of the following claims, and others areequivalent. The claims may be practiced without some or all of thespecific details described in the specification. In many cases, methodsteps described in this specification can be performed in differentorders than that presented in this specification, or in parallel ratherthan sequentially, or in different computers of a computer network,rather than all on a single computer.

The invention claimed is:
 1. An endoscope, comprising: one or more imagesensors designed to capture image data in visible light; one or moreimage sensors designed to capture image data in a nonvisible portion ofthe electromagnetic spectrum; an insertion shaft designed to support theone or more visible and nonvisible image sensors at or near a distal tipwith sufficient rigidity to permit guidance to a surgical site in ahuman body; and image processing software trained through machinelearning to enhance image quality of at least the nonvisible portion ofthe image, and to present the enhanced nonvisible image as a real-time,visible presentation to a surgeon.
 2. The endoscope of claim 1, wherein:the software may be programmed to display the visible presentation ofthe nonvisible image as a split-screen display with the visible lightimage data.
 3. The endoscope of claim 1, wherein: the software may beprogrammed to display the visible presentation of the nonvisible imageoverlaid or merged with the visible light image data.
 4. The endoscopeof claim 3, wherein: the software may be programmed to overlay or mergethe nonvisible image with the visible light image data by registeringfor parallax differences.
 5. The endoscope of claim 3, wherein: thesoftware may be programmed to overlay or merge the nonvisible image withthe visible light image data by recovering three-dimensional spatialrelationships.
 6. The endoscope of claim 1, further comprising: anultraviolet LED mounted within the endoscope to illuminate tissue in thefield of view of the nonvisible image sensor.
 7. the endoscope of claim1, further comprising: an infrared LED mounted within the endoscope toilluminate tissue in the field of view of the nonvisible image sensor.8. The endoscope of claim 1, wherein: the one or more image sensorsdesigned to capture image data in visible light and the one or moreimage sensors designed to capture image data in a nonvisible portion ofthe electromagnetic spectrum are designed into a single image plane. 9.The endoscope of claim 1, wherein: an electronic shutter designed tochop for alternate illumination between multiple illumination sources ofdiffering wavelength or alternate sensing between image sensors ofdiffering wavelength sensitivity.
 10. The endoscope of claim 1, wherein:a strobe circuit designed to chop for alternate illumination betweenmultiple illumination sources of differing wavelength.
 11. The endoscopeof claim 1, wherein: the one or more image sensors designed to captureimage data in visible light, the one or more image sensors designed tocapture image data in a nonvisible portion of the electromagneticspectrum, and image processing software are designed to capture imagedata from tissue below a surface at the field of view of the imagesensors.
 12. A method, comprising the steps of: at a computer imageprocessor, receiving image data from: one or more image sensors designedto capture image data in visible light; one or more image sensorsdesigned to capture image data in a nonvisible portion of theelectromagnetic spectrum; the one or more visible and nonvisible imagesensors being supported on an insertion shaft at or near a distal tipwith sufficient rigidity to permit guidance to a surgical site in ahuman body; and processing the image information through machinelearning image processing trained to enhance image quality of at leastthe nonvisible portion of the image, and presenting the enhancednonvisible image as a real-time, visible presentation to a surgeon. 13.The method of claim 12, wherein: processing the image data for displayof the visible presentation of the nonvisible image overlaid or mergedwith the visible light image data.
 14. The method of claim 13, wherein:processing the image data to overlay or merge the nonvisible image withthe visible light image data by registering for parallax differences.15. The method of claim 14, wherein: processing the image data tooverlay or merge the nonvisible image with the visible light image databy recovering three-dimensional spatial relationships.
 16. The method ofclaim 12, wherein: the one or more image sensors designed to captureimage data in visible light and the one or more image sensors designedto capture image data in a nonvisible portion of the electromagneticspectrum are designed into a single image plane.
 17. The method of claim12, wherein: flashing an electronic shutter designed to chop foralternate illumination between multiple illumination sources ofdiffering wavelength or alternate sensing between image sensors ofdiffering wavelength sensitivity.
 18. The method of claim 12, wherein:strobing for alternate illumination between multiple illuminationsources of differing wavelength.
 19. The method of claim 12, wherein:the one or more image sensors designed to capture image data in visiblelight and the one or more image sensors designed to capture image datain a nonvisible portion of the electromagnetic spectrum and imageprocessing software are designed to capture image data from tissue belowa surface at the field of view of the image sensors.
 20. The method ofclaim 12, further comprising the step of: infusing tissue in the fieldof view of the nonvisible image sensor with contrast fluorescent dye.